CDC167 exhibits potential as a biomarker for airway inflammation in asthma.

Current asthma treatments have been discovered to decrease the risk of disease progression. Herein, we aimed to characterize novel potential therapeutic targets for asthma. Differentially expressed genes (DEGs) for GSE64913 and GSE137268 datasets were characterized. Weighted correlation network analysis (WGCNA) was used to identify trait-related module genes within the GSE67472 dataset. The intersection of the module genes of interest, as well as the DEGs, comprised the key module genes that underwent additional candidate gene screening using machine learning. In addition, a bioinformatics-based approach was used to analyze the relative expression levels, diagnostic values, and reverently enriched pathways of the screened candidate genes. Furthermore, the candidate genes were silenced in asthmatic mice, and the inflammation and lung injury in the mice were validated. A total of 1710 DEGs were characterized in GSE64913 and GSE137268 for asthma patients. WGCNA identified 2367 asthma module genes, of which 285 overlapped with 1710 DEGs. Four candidate genes, CDC167, POSTN, SEC14L1, and SERPINB2, were validated using the intersection genes of three machine learning algorithms, including Least Absolute Shrinkage and Selection Operator, Random Forest, and Support Vector Machine. All the candidate genes were significantly upregulated in asthma patients and demonstrated diagnostic utility for asthma. Furthermore, silencing CDC167 reduced the levels of inflammatory cytokines significantly and alleviated lung injury in ovalbumin (OVA)-induced asthmatic mice. Our study demonstrated that CDC167 exhibits potential as diagnostic markers and therapeutic targets for asthma patients.

Opioid infusions at different times of the day produce varying degrees of opioid-induced hyperalgesia.

BACKGROUND: Opioids are metabolised by enzymes the activities of which vary with the circadian rhythm. We examined whether opioid infusions administered at different times of the day produce varying degrees of opioid-induced hyperalgesia (OIH) in animal experiments and clinical studies. METHODS: Male Sprague-Dawley rats received remifentanil infusions (1 µg kg-1·min-1 for 1 h) at Zeitgeber times (ZT) 0, 4, 8, 12, 16, or 20 h. Rhythmicity of mechanical hypersensitivity was assayed after the infusion. Mechanical hypersensitivity, drug concentration, and metabolic enzyme activity of Wistar rats that received sufentanil (10 µg kg-1; four consecutive i.p. injections at 15-min intervals) or remifentanil infusion at ZT0 or ZT8 were assayed. Sixty patients who underwent abdominal laparoscopic surgery under general anaesthesia received remifentanil infusion (0.15 µg kg-1 min-1) and sufentanil injection (0.2 µg kg-1) at induction and skin incision, respectively. Postoperative pressure pain sensitivity, pain Numeric Rating Scale (NRS), drug concentrations, and nonspecific esterase activity were assessed. RESULTS: Sprague-Dawley rats that received remifentanil infusion exhibited a robust rhythmic paw withdrawal threshold (JTK_CYCLE: P=0.001, Q=0.001, Phase=26). Wistar rats infused with remifentanil or sufentanil at ZT8 exhibited greater OIH (P<0.001) than those infused at ZT0, with higher blood concentrations (P<0.001) and lower metabolic enzyme activities (P=0.026 and P=0.028, respectively). Patients in the afternoon group exhibited higher pressure pain sensitivity at forearm (P=0.002), higher NRS (P<0.05), higher drug concentrations (sufentanil: P=0.037, remifentanil: P=0.005), and lower nonspecific esterase activity (P=0.024) than the morning group. CONCLUSIONS: Opioid infusions administered at different times of day produced varying degrees of OIH, possibly related to circadian rhythms of metabolic enzyme activities. CLINICAL TRIAL REGISTRATION: NCT05234697.

Safety and tolerability of esketamine in propofol based sedation for endoscopic variceal ligation with or without injection sclerotherapy: Randomized controlled trial.

OBJECTIVES: Esketamine is an S (+) enantiomer of ketamine with greater potency and similar psychomimetic effects compared to racemic ketamine. We aimed to explore the safety of esketamine in different doses as an adjuvant to propofol in patients undergoing endoscopic variceal ligation (EVL) with or without injection sclerotherapy. METHODS: One hundred patients were randomized to receive sedation with propofol 1.5 mg/kg in combination with sufentanil 0.1 µg/kg (group S), esketamine 0.2 mg/kg (group E0.2), esketamine 0.3 mg/kg (group E0.3), or esketamine 0.4 mg/kg (group E0.4) for EVL (n = 25 each). Hemodynamic and respiratory parameters were recorded during the procedure. The primary outcome was the incidence of hypotension; secondary outcomes included the incidence of desaturation, positive and negative syndrome scale (PANSS) after the procedure, pain score after the procedure, and secretion volume. RESULTS: The incidence of hypotension was significantly lower in groups E0.2 (36%), E0.3 (20%), and E0.4 (24%) than in group S (72%). The incidence of SpO2 ≤94% was significantly lower in group E0.4 (4%) than in group S (32%). No significant intergroup difference was found in the PANSS assessment. CONCLUSIONS: Combining 0.4 mg/kg esketamine with propofol sedation was optimal to facilitate EVL with stable hemodynamic status and better respiratory function during the procedure, without significant psychomimetic side-effects. TRIAL REGISTRATION: Chinese Clinical Trial Registry (Trial ID: ChiCTR2100047033, http://www.chictr.org.cn/showproj.aspx?proj=127518).

Effects of crustacean hyperglycaemic hormone RNA interference on regulation of glucose metabolism in Litopenaeus vannamei after ammonia-nitrogen exposure.

To unveil the adaptation of Litopenaeus vannamei to elevated ambient ammonia-N, crustacean hyperglycaemic hormone (CHH) was knocked down to investigate its function in glucose metabolism pathway under ammonia-N exposure. When CHH was silenced, haemolymph glucose increased significantly during 3-6 h, decreased significantly during 12-48 h and recovered to the control groups' level at 72 h. After CHH knock-down, dopamine (DA) contents reduced significantly during 3-24 h, which recovered after 48 h. Besides, the expressions of guanylyl cyclase (GC) and DA1R in the hepatopancreas decreased significantly, while DA4R increased significantly. Correspondingly, the contents of cyclic AMP (cAMP), cyclic GMP (cGMP) and diacylglycerol (DAG) and the expressions of protein kinase A (PKA), protein kinase G (PKG), AMP active protein kinase α (AMPKα) and AMPKγ were significantly down-regulated, while the levels of protein kinase C (PKC) and AMPKß were significantly up-regulated. The expressions of cyclic AMP response element-binding protein (CREB) and GLUT2 decreased significantly, while GLUT1 increased significantly. Moreover, glycogen content, glycogen synthase and glycogen phosphorylase activities in hepatopancreas and muscle were significantly increased. Furthermore, the levels of key enzymes hexokinase, pyruvate kinase and phosphofructokinase in glycolysis (GLY), rate-limiting enzymes citrate synthase in tricarboxylic acid and critical enzymes phosphoenolpyruvate carboxykinase, fructose diphosphate and glucose-6-phosphatase in gluconeogenesis (GNG) were significantly decreased in hepatopancreas. These results suggest that CHH affects DA and then they affect their receptors to transmit glucose metabolism signals into the hepatopancreas of L. vannamei under ammonia-N stress. CHH acts on the cGMP-PKG-AMPKα-CREB pathway through GC, and CHH affects DA to influence cAMP-PKA-AMPKγ-CREB and DAG-PKC-AMPKß-CREB pathways, thereby regulating GLUT, inhibiting glycogen metabolism and promoting GLY and GNG. This study contributes to further understand glucose metabolism mechanism of crustacean in response to environmental stress.

Washing Lipoaspirate Improves Fat Graft Survival in Nude Mice.

BACKGROUND: The optimal fat processing technique of fat grafting has not been determined. We have proved the importance of washing lipoaspirate to remove blood, but the necessity of washing when there is no obvious bleeding during liposuction is not clear. OBJECTIVES: The purpose of this study is to further investigate the effect of washing on fat graft survival and the underlying mechanisms, from the perspective of inflammation, oxidative stress and apoptosis. METHODS: To exclude the influence of blood, de-erythrocyte infranatant (dEI) isolated from lipoaspirate was obtained. Purified fat processed by cotton pad filtration mixed with dEIs after sedimentation (sedimentation group), washing (washing group) or phosphate buffer solution (control group) was transplanted to nude mice subcutaneously. Samples were harvested at 1 day and 1, 3, 8 weeks after transplantation. Volume and weight retention, histologic examination, immunostaining of perilipin-1, CD31, CD45 and Ly6g, mRNA expression of PPAR-γ, C/EBPα, VEGF, bFGF, IL-6, IL10, TNF-α, TGF-ß, Bax and Bcl-2, and protein contents of 8-iso-PGF2α, IL-6, IL10, TNF-α and TGF-ß were all compared among groups. RESULTS: After transplantation, volume and weight retention, histologic scores, viable adipocytes and vascularization were all improved in the washing group, with increased expression of adipogenic and angiogenic genes. Compared with the sedimentation group, the washing group had milder inflammation, lower levels of oxidative stress and apoptosis. CONCLUSIONS: Washing lipoaspirate to eliminate mixed components can improve fat graft survival and promote adipogenesis and angiogenesis, possibly by relieving inflammation, reducing oxidative stress injury and inhibiting apoptosis. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of 47 these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

The effect of different dietary levels of sodium and chloride on performance, blood parameters and excreta quality in goslings at 29 to 70 days of age.

The purpose of this study was to ascertain the appropriate levels of dietary sodium (Na+ ) and chloride (Cl- ) for 29- to 70-day-old goslings and to investigate the effects of different levels of Na+ and Cl- on the growth performance, water consumption, blood parameters and excreta quality of goslings to provide a reference for the healthy production of goslings. In Experiment 1, a total of 432 29-day-old male Jiangnan White goslings were randomly allotted to nine treatments according to a 3 × 3 factorial design, with six pens containing eight birds per treatment. The goslings were fed diets with three concentrations of Na+ (0.10%, 0.15% and 0.20%) and three concentrations of Cl- (0.15%, 0.20% and 0.25%). The experimental period was 42 days. In Experiment 2, a total of 24 70-day-old Jiangnan White goslings were selected for four treatments (0.10% Na+  × 0.15% Cl- ; 0.10% Na+  × 0.25% Cl- ; 0.20% Na+  × 0.15% Cl- and 0.20% Na+  × 0.25% Cl- ) and housed separately in metabolic cages. The faeces were collected for 3 consecutive days. In Experiment 1, the average daily feed intake (ADFI), average daily gain (ADG) and feed/gain (F/G) ratio of goslings were unaffected by the treatments. However, low levels of Na+ and Cl- significantly reduced the water consumption of goslings in the later growth period (p < 0.05). The average water consumption of goslings fed with 0.10% Na+  × 0.15% Cl- was significantly lower than that of the goslings fed with 0.20% Na+  × 0.25% Cl- (56 days, 1304.2 ml vs. 1471.7 ml; 63 days, 1452.8 ml vs. 1610.8 ml; 70 days, 1540.0 ml vs. 1775.4 ml; p < 0.05). The interaction between Na+ and Cl- (Na+  × Cl- ) had a significant impact on the blood haemoglobin (HGB) and haematocrit (HCT) levels in the goslings (p < 0.05). HGB increased linearly with increasing levels of Na+ . HGB and HCT first increased and then decreased with increasing levels of Cl- . In Experiment 2, Na+ and Cl- levels had significant effects on the excreta moisture content (p < 0.05). Goslings fed with 0.10% Na+  × 0.15% Cl- had a low moisture content of 5.58% compared to the goslings fed with 0.20% Na+  × 0.25% Cl- (87.51% vs. 93.09%; p < 0.05). The levels of dietary Na+ had a significant effect on the retention ratio of Na (p < 0.05), with the value for the 0.20% Na+ group being significantly higher than that for the 0.10% Na+ group (p < 0.05). In summary, different levels of Na+ and Cl- did not affect the growth of goslings. To reduce the water consumption and moisture content of excreta, the Na+ and Cl- levels in the diet can be as low as 0.10% and 0.15%, respectively.

Dedifferentiation of Human Adipocytes After Fat Transplantation.

BACKGROUND: Fat transplantation is a common method employed to treat soft-tissue defects. The dedifferentiation of mature adipocytes has been well documented, but whether it occurs after fat transplantation remains unclear. OBJECTIVES: The major purpose of this project was to investigate the dedifferentiation of mature adipocytes after fat transplantation. METHODS: Human lipoaspirate tissue was obtained from 6 female patients who underwent esthetic liposuction. Mature adipocytes were extracted and labeled with PKH26, mixed with lipoaspirate, and injected into nude mice. In addition, PKH26+ adipocytes were subjected to a ceiling culture. Grafted fat was harvested from nude mice, and stromal vascular fragment cells were isolated. The immunophenotype of PKH26+ cells was detected by flow cytometry analysis at 2 days and 1 week. The PKH26+ cells were sorted and counted at 2 and 4 weeks to verify their proliferation and multilineage differentiation abilities. RESULTS: Two days after transplantation, almost no PKH26+ cells were found in the stromal vascular fragment cells. The PKH26+ cells found 1 week after transplantation showed a positive expression of cluster of differentiation (CD) 90 (CD90) and CD105 and a negative expression of CD45. This indicates that the labeled adipocytes were dedifferentiated. Its pluripotency was further demonstrated by fluorescent cell sorting and differentiation culture in vitro. In addition, the number of live PKH26+ cells at week 4 [(6.83 ± 1.67) × 104] was similar with that at week 2 [(7.11 ± 1.82) × 104]. CONCLUSIONS: Human mature adipocytes can dedifferentiate into stem cell-like cells in vivo after fat transplantation.

Effects of working pressure and power on photovoltaic and defect properties of magnetron sputtered Sb2Se3 thin-film solar cells.

Antimony selenide (${\text{Sb}_2}{\text{Se}_3}$Sb2Se3) is an emerging material with potential applications in photovoltaics, while magnetron sputtering is an important method in material growth. In this study, ${\text{Sb}_2}{\text{Se}_3}$Sb2Se3 thin films, prepared by the magnetron sputtering technique with varied working pressures and sputtering powers, were fabricated into solar cells with a structure of $\text{glass}/\text{ITO}/\text{CdS}/{\text{Sb}_2}{\text{Se}_3}/\text{Au}$glass/ITO/CdS/Sb2Se3/Au. The current density versus voltage measurements and x-ray diffraction were introduced to compare the photovoltaic and structural properties of the cell samples. Characterization and identification of the defects in ${\text{Sb}_2}{\text{Se}_3}$Sb2Se3 thin films were investigated by admittance measurements. The ${\text{Sb}_2}{\text{Se}_3}$Sb2Se3 cell samples prepared with appropriate sputtering power (about 60 W) or working pressure (about 0.4 Pa) were found to own better crystal qualities and lower defect densities, which may be the reason for better efficiency.

The effect of different dietary levels of sodium and chloride on performance and blood parameters in goslings (1-28 days of age).

A total of 702 1-day-old male Jiangnan White goslings were used to study the effects of varying levels of Na+ and Cl- on their growth performance and blood parameters. In this experiment, goslings were randomly allotted to nine treatments, with six pens per treatment in a 3 × 3 factorial arrangement, and fed diets with three concentrations of added Na+ (0.10%, 0.15% and 0.20%) and three concentrations of added Cl- (0.15%, 0.20% and 0.25%). The purpose of this experiment was to investigate the sensitivity of goslings to Na+ and Cl- during brooding to determine the appropriate levels of Na+ and Cl- in their feed. The results are as follows: (a) Different levels of Na+ and Cl- in the diet, especially low Na+ and Cl- , significantly affected the body weight (BW), average daily gain (ADG) and feed/gain ratio (F/G) of the 28-day-old goslings (p < .05). But Na+  × Cl- has no significant effect on water consumption (p > .05). (b) Serum concentrations of urea increased linearly with Na+ content (p < .05). Serum concentrations of creatinine (CR) and uric acid (UA) increased linearly with Cl- content (p < .05). (c) Na+  × Cl- has a significant impact on the serum sodium (Na) and chlorine (Cl; p < .05). The content of serum Na and Cl increased linearly with increasing levels of Na+ and Cl- . These results show that low levels of Na+ and Cl- had significant adverse effects on the growth of 1- to 28-day-old goslings. The results of the experiment support a recommendation to supplement the diet of goslings with 0.20% Cl- and not <0.15% Na+ .

Calcium channel blockers for pulmonary arterial hypertension.

BACKGROUND: Pulmonary arterial hypertension (PAH) is one of several forms of pulmonary hypertension: a chronic disease of the pulmonary vasculature. The mean age at diagnosis is around 50 years old, with increasing prevalence in people over 70 years old (10% to 17%). The median survival to be approximately seven years with one-, three-, five-, and seven-year survival rates from time of diagnostic right-sided heart catheterization were 85%, 68%, 57%, and 49%, respectively. Several studies showed that calcium channel blockers (CCBs) reduce right ventricular hypertrophy and improve long-term haemodynamics in PAH. OBJECTIVES: To evaluate the clinical efficacy and harms of CCBs for people with PAH. SEARCH METHODS: The search strategy was provided by the Cochrane Airways Group Trials Search Co-ordinator. The following databases were searched from their inception until September 2014: the Cochrane Airways Group Register of Trials (CAGR); the Cochrane Central Register of Controlled Clinical Trials (CENTRAL) (The Cochrane Library,Issue 8 2014); MEDLINE (1948 to September 2014); EMBASE (1974 to September 2014); ClinicalTrials.gov; WHO trial portal; the Chinese Biomedical Databases (1979 to September 2014); CNKI: the Chinese Journals Full Text Database (1979 to September 2014), the Chinese Journals Full Text Database Century Journals (1979 to September 2014), the Chinese Doctoral Degree Thesis Full Text Database (1979 to September 2014), the Chinese Outstanding Master Degree Thesis Full Text Database (1979 to September 2014); VIP Database (1989 to September 2014) and WANFANG Database (1993 to September 2014). No language restriction was applied. SELECTION CRITERIA: Fully published randomized controlled trials (RCTs) comparing CCBs with placebo or other treatment, or comparing CCBs as an adjunct to other treatments with other treatments alone, in patients with PAH. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. MAIN RESULTS: We found one RCT to include in this review but it was published only in abstract form with no data for evaluation. AUTHORS' CONCLUSIONS: Currently, as there is lack of valid evidence, the efficacy and safety of CCBs is unproven in the treatment of PAH. However, the search strategy used for this review did identify four controlled clinical trials without randomization, three of which suggested treatment with CCBs may be beneficial in PAH. No adverse side effects of CCBs were reported. Confirmation of these findings by RCTs is recommended.

Research on the dynamic tensile characteristics and surface crack evolution of coal under impact loading.

The tensile properties of coal under dynamic loading are important mechanical characteristics of coal and are highly important for controlling coal rock stability under impact loading conditions, selecting blasting engineering parameters, and studying the mechanism of rockburst disasters. To investigate the dynamic tensile failure process of coal subjected to impact loading, this study used high-speed photography and digital image correlation technology to capture the dynamic tensile failure of coal under impact loading. The dynamic tensile evolution was quantitatively analyzed from the beginning of coal sample being loaded to failure. The captured images of the coal were processed, and the fractal dimension was used to quantitatively describe the evolution of the coal surface cracks under impact loading. The following conclusions were drawn from the experimental results: (1) An empirical formula was established to describe the dynamic tensile strength characteristics of coal under different loading rates. (2) Under impact loading, the maximum strain of a Brazilian disc coal sample first appeared at the contact end between the sample and the incident rod. (3) Under impact loading, a Brazilian disc coal sample cracked from the center of the sample outward, and the crack subsequently extended toward both ends. The fractal dimension of the crack exhibited a power function relationship with time, and the variation range of the fractal dimension of the crack was 1.05-1.39.

Postoperative esketamine improves ventilation after video-assisted thoracoscopic lung resection: A double-blinded randomized controlled trial.

Background: Pain management after lung resection plays a crucial role in reducing postoperative pulmonary complications (PPCs). This study aimed to examine the effect of postoperative esketamine infusion as an adjunct to opioid analgesia on ventilation and pulmonary complications in patients underwent lung resection. Methods: Patients undergoing video-assisted thoracoscopic lung resection were randomly assigned to either the esketamine group or the control group. The esketamine group received a 24-h infusion of 1.5 mcg/ml sufentanil combined with 0.75 mcg/ml esketamine after surgery, while the control group received 1.5 mcg/ml sufentanil alone. The primary outcome measure was low minute ventilation, and the secondary outcome measures were hypoxemia, PaO2/FiO2 levels, postoperative pulmonary complications, hospital stay duration, ambulation time, Visual Analogue Scale (VAS) score, depression and anxiety levels, sleep quality, and analgesia satisfaction. Results: 80 patients were randomly divided into two groups: the esketamine group (n = 40) and the control group (n = 40). The esketamine group exhibited notably reduced incidence of low minute ventilation (P = 0.014), lower occurrence of postoperative pulmonary complications (PPCs) compared to the control group (P = 0.039), and decreased incidence of hypoxemia (P = 0.003). Furthermore, the esketamine group showed improved outcomes with lower VAS scores on the second postoperative day and enhanced sleep quality (P < 0.001) after the surgery. Conclusions: Postoperative esketamine infusion with opioids improved ventilation and reduced PPCs after lung resection, warranting further clinical studies. Trial registration: This study was registered on ClinicalTrials.gov (Trial ID: NCT05458453, https://clinicaltrials.gov/ct2/show/NCT05458453).

Slower intravenous tramadol administration can prevent nausea and vomiting and predict postoperative nausea and vomiting: a randomized controlled trial.

Objective: Nausea and vomiting are the most common complications in patients who use tramadol for analgesia. This study evaluated the risk of nausea and vomiting related to intravenous tramadol administration. Methods: In this study, 315 patients who received pre-analgesia before elective surgery were selected, and participants were divided into groups based on the Apfel risk assessment of nausea and vomiting, as follows: high risk (Apfel=4), medium risk (Apfel=2-3), and low-risk (Apfel=1). Tramadol (1.5 mg/kg) was administered intravenously over a duration of 1 min, 2 min, or 3 min before anaesthesia induction to observe preoperative nausea and vomiting reactions within 10 min. Results: In the low-risk group, the numeric rating scale for postoperative nausea scores and the incidence of nausea and vomiting were significantly lower in the 3-min group than those in the 1-min group, and the incidence of preoperative nausea and vomiting after intravenous administration of tramadol in the 1-min and 3-min groups were significantly related to the incidence of postoperative nausea and vomiting. The incidence of nausea and vomiting during pre-administration in the 1-min and 3-min groups was identified as an independent risk factor for postoperative nausea and vomiting. Conclusions: In the clinical treatment of pain with tramadol, the slow intravenous application of tramadol within 3 min is worthy of being adopted and promoted by clinicians in their daily work.

Effect of noise isolation using noise-cancelling headphones during laparoscopic surgery for postoperative pain reduction: A randomized clinical trial.

STUDY OBJECTIVE: Most laparoscopic surgeries under general anesthesia are performed in noisy environments, although the effect of intraoperative noise reduction on postoperative pain remains uncertain. This study aimed to explore whether postoperative pain could be reduced through the intraoperative use of noise-cancelling headphones. DESIGN: This study was conducted as a prospective parallel-group randomized clinical trial. SETTING: Operating room and surgery room. PATIENTS: Ninety patients who underwent laparoscopic surgery under general anesthesia. INTERVENTIONS: In the intervention group, noise-cancelling headphones were used to reduce noise intensity during laparoscopic surgery under general anesthesia. MEASUREMENTS: The primary outcome was the maximum movement-evoked pain intensity within 24 h post-surgery, measured using a 10-point numeric rating scale. Secondary outcomes included the maximum resting pain score and total opioid consumption during the 24-h period post-surgery. Mean intraoperative noise and the proportion of intraoperative time with noise intensity ≥70 dB were recorded. MAIN RESULTS: The maximum movement-evoked pain score was significantly lower in the intervention group than in the control group (mean score [SD], 2.7 [1.0] and 4.0[1.0], respectively; P < 0.001). The intervention group required significantly fewer opioids than the control group (mean [SD], 44.2 [12.8] and 51.3[17.5] mg, respectively; P = 0.032). In the control group, but not the intervention group, all postoperative pain scores were significantly associated with the proportion of intraoperative time with noise intensity ≥70 dB, which was an independent risk factor for postoperative pain. CONCLUSION: During laparoscopic surgery under general anesthesia, intraoperative noise isolation using noise-cancelling headphones is a safe and effective strategy for relieving postoperative pain and decreasing total opioid analgesic consumption.

Prevalence and time course of postoperative nausea and vomiting and severe pain in patients under general anesthesia with patient-controlled intravenous analgesia.

Introduction: Postoperative nausea and vomiting (PONV) and pain are common and distressing complications in patients undergoing surgery. However, it remains uncertain whether timing of the postoperative course or the diel rhythm influences the occurrence of PONV or severe pain. Therefore, we aimed to explore the temporal distribution of PONV and severe pain. Material and methods: In this prospective observational study, we enrolled patients aged 18-65 years with American Society of Anesthesiologists classifications I-III, who were scheduled for surgery under general anesthesia. Patients were visited postoperatively at regular intervals (every 6 h over a 24-h period). Incidence of PONV was recorded and categorized based on real-time divisions: before dawn (00:00-05:59), morning (06:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59) and as sequential periods (i.e., 0-6, 6-12, 12-18, and 18-24 h). Severe pain and use of additional remedies were also recorded. Results: A total of 724 patients were included in the final analysis. Of these, 14.92 % experienced PONV within the first 6 h, and 8.29 % received antiemetic therapy. Occurrence of PONV and administration of remedies declined over the 24-h postoperative period. The lowest rate of PONV was observed during the pre-dawn hours (5.66 %). There was no statistically significant difference in the incidence of PONV 24-h postoperatively between surgeries with different end times. Patients underwent orthopedic surgeries had the highest incidence of PONV during 18:00-23:59, gynecological surgery patients had the highest incidence at 12:00-17:59, and 6:00-11:59 for other surgery patients. All patients had the lowest incidence during 0:00-5:59. During the initial 6-h postoperative period, 24.59 % of patients experienced severe pain, which declined in the remaining episodes. Patients who underwent orthopedic and gynecological surgeries exhibited similar temporal patterns and distribution characteristics of PONV and severe pain. Discussion: Both PONV and severe pain declined within the 24-h postoperative period, particularly within the first 6 h. Additionally, the onset patterns of PONV vary among patients undergoing different types of surgeries, all patients demonstrated decreased susceptibility to PONV between 00:00-05:59. Our findings enhance prevention and treatment strategies within an optimized timeframe during the postoperative course.

Case scenario about TEE: Patient with dilated cardiomyopathy undergoing laparoscopic cholecystectomy.

A 42-year-old woman, who presented with DCM (American Society of Anesthesia, ASA class IV), suffered from gallstone for years, and was scheduled for laparoscopic cholecystectomy. Echocardiography demonstrated a severely dilated left ventricle with global hypokinesia and reduction of left ventricular systolic function, ejection fraction (EF) 34% with mild mitral regurgitation and severe tricuspid regurgitation. After intubation, a transesophageal echocardiography (TEE) probe was inserted. When the IAP was gradually ascended to 14 mmHg during the laparoscopy, EF fell to 19% and the systolic pressure fell to 78 mmHg and TEE showed severely poor wall motion. But the central venous pressure (CVP) still showed about 4 mmHg throughout the whole procedure. After decreasing the IAP to 10 mmHg, we adjusted the rate of pacemaker to 70 times per minute then the systolic pressure was kept at around 100 mmHg, and the diastolic pressure was kept at 60 mmHg. EF was 30% after the reduction of IAP and the adjusting of the heart rate set. TEE is a helpful monitor in anesthesia management of patients with DCM during noncardiac surgery and CVP is useless especially for the procedure with severe hemodynamic effects.

Effects of Dietary Sodium and Chloride on Slaughter Performance, Digestive Tract Development and Tibia Mineralization of Geese.

This study evaluated the slaughter performance, digestive tract development and tibia mineralization effects of sodium (Na) and chloride (Cl) on geese. Four hundred and thirty-four male geese at 29 days were randomly assigned into nine groups with six replicates (eight in each). The experiment employed a 3 × 3 factorial design, with two instances each of three Na levels (0.10%, 0.15%, and 0.20%) and three Cl levels (0.15%, 0.20%, and 0.25%). All experimental birds were husbanded for 42 days. Dietary Na and Cl levels and their interactions (Na ×Cl) had no significant effect on the slaughter, breast, thigh, abdominal fat yield, and digestive tract index of geese (p > 0.05). However, dietary Na and Cl level significantly affected the crypt depth of the jejunum and tibial development. Variations in Na and Cl levels had a significant interaction on the crypt depth of jejunal (p < 0.05), 0.20% Na × 0.25% Cl had a minor crypt depth. Dietary variations in Na and Cl significantly affected the tibial strength, and there was a significant interaction between them (p < 0.05). When Na and Cl were at their maximum (0.20% Na and 0.25% Cl), the strength of the tibia was the lowest. In addition, a single factor (Na or Cl) had no effect (p > 0.05), but its interaction significantly affected the calcium (Ca) content of bone (p < 0.05). When the Na and Cl levels were 0.15% and 0.15%, respectively, the Ca content in bone was the highest. These results suggest that dietary Na and Cl had interactive effects on geese, especially in the development of the tibia. High dietary Na and Cl levels adversely influenced the tibia and intestinal crypt morphology. Therefore, we do not advocate supplementing too much Na or Cl in the diet. Combined with our previous results, for 29-70-day-old geese, it is recommended that dietary Na and Cl levels should be 0.10% and 0.15%, respectively.